Shoes for paralytic patients



April 4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 1Filed Dec. 16, 1958 INVENTOR flzr/cav BE/vase BY 476 ATTO R N EY April4, 1961 A. BENESCH SHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 2 FiledDec. 16, 1958 INVENTOR FRED F'A/ ATTO R N EY April 4, 1961 A. BENESCHSHOES FOR PARALYTIC PATIENTS 5 Sheets-Sheet 3 Filed Dec. 16, 1958INVENTOR A; FEED BEA/58Gb BY 44 6M ATTO R NEY April 1951 A. BENESCH2,977,692

SHOES FOR PARALYTIC PATIENTS Filed D80. 16, 1958 5 Sheets-Sheet 4INVENTOR #4 A'Ptl) \FENE'SCH wwwm ATTORNEY April 4, 1961 A. BENESCHSHOES FOR PARALYTIC PATIENTS 5 Sheets-$heet 5 Filed Dec. 16, 1958INVENTOR ,00 flzFRED BENE'SCH ATTORNEY 0% rm W l a 0 I Z 4 7- q 2 m 4 7.6 6 m w SHOES FOR PARALYTIC PATIENTS Alfred Benesch, 25 Nagle Ave., NewYork 40, NY.

Filed Dec. 16, 1958, Ser- No. 780,713 '5 Claims. (Cl. 36-85) Thisinvention relates to shoes for paralytic patients.

In the treatment of patients who have suflered paralysis, particularlyin cases of the youngv who have suffered cerebral palsy, thepractitioner has to contend with the injury resulting in such caseswhere the patient tends to stand on his toes even when the foot is inthe shoe. In such cases, the practitioner seeks to draw the heel of thepatients foot down against the insole of the shoe in order to attain arelatively normal walking position for the foot of the patient. Thepractitioner, however, is unable to visualize the actual results oftheadjustments. he is making when an ordinary shoe is used; he also isunable to measure whether he is applying pressure to the foot of. thepatient in excess, of that necessary to attain the result he is'seeking,and thus actually may inflict actual injury.

It is an object of the invention to provide, for a patient of this type,a shoe which outwardly has the appearance of ordinary footwear, butwhich has a structure by which the practitioner is enabled positively toapply a controlled force to the foot of the patient and simultaneouslyto determine the progress and extent I of the adjustment being made bynoting continuously the position of the heel of the foot itself inrelation to the related parts of the shoe, and particularly indetermining 'the'position of the heel of the foot with relation to the Vinsole of the shoe in seeking to attaina position of the foot withrelation to the insole.

'itsdesired normal position upon :It' is an object ofthe invention toprovide elements efiectiveifor drawing theheel of' such a ,patientjdownagainst the insoleofra shoe wherejtheelements are anchoreddirectly'tothe insole in the' assembly of the shoe. Itisjan object ofthe invention toprovidemeans for rigidifyin'gi the shoe of a: paralyticpatient with;,relation to;his fo'ot -;in establishing a definiterelationship between .-the heel f the foot and the h'eelportion, ofthegi'nsole "of the shoe; wherein such meanstoproduce-this effect isconcealed was not to bes-eenat the outside Qf the shoe, but whereinthemovernentand positionof the heel of a the foot-with relation to the;heel Of the insole may be 1 observed throughout the time the adjustmentis being a made;

with a,-?-counterwhich is'molded from a translucent plastic sci-that;after such counter has beenassembled Other 7 :exernplii'ying the,inventio ever is liotintendedi'f to v be dreobjects of the:inventionrwill bejset forthlhere- ..;,inaiter, ;or; will beapparentgfronrthegdescriptipn'andf .the drawings, 1 in which are; -illustrated embodiments Un sms arsn 2,977,692 Patented Apr. 4, 191

lar arrangement of parts, or any particular application of any suchconstruction or arrangement of parts, or any specific method ofoperation or use, or any of the various details thereof, even wherespecifically shown "and described herein, as the samemay be modified invarious particulars, or may be applied in many varied relations, withoutdeparting from the spirit and scope of the claimed invention, of whichthe exemplifying embodiments, herein shown and described, are intendedonly to be illustrative, and only for the purpose of complying with therequirements of the statutes for disclosure of an operative embodiment,but not to show all the ,various forms and modifications in which theinvention might be embodied.

. On the drawings, in which the same reference characters refer to thesame parts throughout, and in whic are disclosed such practicalconstructions,

Fig. 1 is a perspective view of a counter formed in accordance with theinvention;

Fig. 2 is an exploded view of the upper,- and the lining for the upper,shown one above the other, and indicating the manner in which the liningis inserted within the upper;

Fig. 3 is a transverse cross-sectional view, substantially on the line33of the parts shown in Fig. 2 but the part's'beingshown assembled;

Fig. 4 is a perspective view, showing the last, with the insoledisposed'upon the last, as one of the stages of the assembly of the shoeof the invention;

Fig. 5 is an exploded view in perspective, showing the relationship ofthe counter to the assembled lining and upper, and the direction of theassembly of the counter with the upper and lining; i Fig. 6 isatransverse cross-sectional view, substantially on the line 6-6 of Fig.5, showing the assembled re lationship of counter, lining and upper;

Fig. 7 is an exploded view in perspective, showing the disposition ofthe counter, upper, bracing means, lining, andthe spring bridge upontheinsole,and with the welt in place, all assembled upon the last, with thesole (to be applied to the shoe) shown positioned above the welt andinsole to which it is to be secured; r

Fig. 8 is an exploded view, showing the shoe remove fromtthe last aftersole and heel have been assembled with the shoe, and after the strap fora brace has. been Fig. 9 is a perspective view showing a manner ofconstruction of-a bracing means to be assembled with the ,shgeforgadusting the position of the heel of the foot with -relation to theshoe itself; g g

Fig. '10 is an exploded view illustrating a manner in which the bracingmeans may beassembled with the shoe;

Fig. 1'1 'is a longitudinal vertical.cross sectionalview of a shoe inaccordance with the invention, showing the -bracing means and theattaching means for sustaining {a braceor similar device in position;

Fig. 12 ise transversecross-sectional view, substantialily on thelineg-12-12 of Fig. 11;

Fig. .133. is a transversecross-sectional view, substantially on theline 13- -13 of Fig. 11; 't l4 is an end perspective view at the heel:end of Ta shoe, showing a portion of the upperopened up so as tomakevisible the adjustments of the foot as; seen through the translucentcounter; and l 15 isa view similar to a portion of Fig. 11 to illus-,trate a modification of the assembly of, the bracing means;

' In constructing ashoeitl toobtain the results desired I herein, .someusual procedures. employed in the .manufacture of the shoe may beemployed to make theshbe.

,offthis invention. ;At ,least a portion of the shoe near heelis. openedupj'injthe manner described, .and yet them into position.

Now this assembly, so defined, is droppedrover last11 to which insole 12has been tacked in position, and porthe shoe is made useful in the usualmanner aside from its utility in the making of the adjustments heredescribed. The usual last 11 may be utilized in making the shoe of thisinvention. The shoe to be constructed may be of any usual type, such asthe welt type or other well known shoe construction. For purposes ofillustration, the invention will be disclosed in connection with a shoeof the welt construction, but such specific disclosure is not intendedto limit the application of the invention. In

. the illustrated method, an insole 12 is tacked to last 11.

The insole, in the usual manner, is shaped to the general contourof thelast.

A portion 14 of leather, which may be substantially half the length ofinsole lZ, is positioned and worked directly upon the insole which isattached to the last itself, to produce bracing means 16. The leather orother material used in forming portion 14 may be skived or otherwiseshaped to the contour of the last and the insole, and to thin it down soas to form a smooth junction with the insole at instep 18. To portion 14are now aflixed a pair of flexible, preferably leather, straps 20. Thesestraps (see Fig. 11) are intended to be brought to bear against the footat position 22 in advance of the instep. They are prepared'of asuflicient width to distribute the pressure against the skin and tissueof the wearer so as not to be unbearable during the manipulations to beexplained and the wearing of the shoe theresecured to portion 14. Atends of straps 20, suitable means may be provided for drawing ends 30together. For instance, lace holes 32 may be provided for the receptionof lacing 34.

An upper 36 may have been constructed off the last in the usual fashion.In this case, an upper of the blucher type of upper is utilized, andconsists of a toe or tip portion 38, and the usual tongue 40 positionedbetween flaps 42 such as are provided for a blucher type shoe. All ofthis terminates in the heel part 44 of the upper. Flaps 42 are united attheir rear ends by a seam 46. At their front or free ends 48, the flaps42 may be provided with any suitablef astening means. In the structureillustrated, lacing holes 50 are provided to receive lacing 52. A lining54. of the usual'lining material, cut to substantially the same shape asupper 36, tip portion 38 and flaps 42, may be provided, and be securedat selected anchor points to upper 36, leaving the lower edges 56 and 58of upper and lining, respectively, free, although the remaining parts ofupper and lining may be cemented together.

Lining 54(Figs. 3 and 13) is positioned withinupper 36. Portions of thelining and the upper at upper areas may be secured together, as,forinstance, by cementing, before proceeding with the furtherprocessing. A counter 60 maybe pushed between lining 54 and upper 36 attheir lower ends (Figs. 5 and 6). j

Counter 60 (Figs. 1 and 5) maybe made by molding to the desired formfrom a suitable material, such as a translucent plastic. 7 Such acounter may comprise a continuous wall 62 including sidewalls 64 joinedtogether by a curved rear wall 66. The bottom edges are bounded byflanges 68. When counter 60 is assembled between lining 54 and upper 36by being pushed between them at their lower ends, the parts may besecured together in any preferred manner, as, for instance, by cementing4 tion 14 with its straps 20 has been secured (Fig. 7). Lower edges 56of upper 36, together with lower edges 58 of lining 54, are turnedaround flanges 68 and upon insole 12, and these turned edges and flanges68 are secured to the insole by suitable means. The method of securingmay be that generally used in the trade, as, for instance, tacking, theuse of adhesive, or the like.

A welt 70 may now be positioned upon the portions of the turned andsecured edges 56 and 58, the welt extending up to and terminating justat the boundary of heel portion 72 of insole 12 upon which portion 14-has been superimposed. The welt may be secured in position in theconventional manner; for instance, it may be adhered adhesively, or itmay be stitched to the secured together edges of upper, lining, insole,and portion 14. A steel shank 74 may now be assembled to bridge fromheel portion to instep 18.

A sole 76 is shown (Fig. 7) in position above the assembled portions ofupper 36, lining 54, portion 14, counter 60, and insole 12. Theassembled parts, without sole 76, but with last 11 still within shoebody 78 thus formed, may be taken to a suitable machine to stitch sole76 to the welt 70, or otherwise to secure the sole in position. Heel 24may be assembled upon sole 76 (Fig. 8). Then last 11 may be removed fromthe shoe thus constructed.

In Fig. 10, bracing means 16 is shown separated from the last. In oneprocess of manufacture, bracing means 16, consisting of the partsalready described, may be made up separately from the shoe assembly bydoing the shaping of portion 14 and other work of joining straps 20 toportion 14 apart from the insole and upper. In such case, a constructionsuch as shown in Fig. 15 may be produced, where insole 12 and its steelshank 74 will be the outermost parts to which the end edges of upper andlining and the flanges of the counter are secured. Bracing means 16, asshown, are pushed through the open end 80 of the upper (Fig. 10) againstface 82 of the insole, and there secured in position by suitable means,as, for instance, adhesive or the like. Bracing means 16 now covers asubstantial portion of face 82. Straps 20 extend up within the shoe bodyin either method of construction. A lining 84 (Figs. 11 and 12) may nowbe applied to top face 86 .of bracing means 16 and the rest of theuncovered portion of face 82. The lining may be secured in place as, forinstance, by being adhesively applied. Where portion 14 (Fig. 11) ispositioned below insole 12, lining 84 would cover the entire face 82 ofthe insole. Upper 36 atits rear section 88 (Figs. 2 and 14) is splitapart. Portions of upper and lining are left unadhered to counter 60 atthis position so that these portions may be moved aside, as flaps'90 and92. Thus it is possible to inspect conditions within the interior of theshoe through the window provided by the translucent or transparent wallsof counter 60. Suitable means, such as a strap 94 and a buckle 96, maybe provided for holding flaps 90 and 92 closed normally when the shoe isin ordinary use. When buckle 96 and strap 94 are undone, flaps 90 and 92may be moved aside, and thereupon the practitioner may observe all theoperations which will ensue during manipulation of bracing means 16.

' A braceof a type sometimes worn by patients who wear shoes of thistype may be assembled with heel 24.

The bottom strap 98' of a brace (not shown) of this type is shownextended through a passage 100 which may be cut* or otherwise formed toextend through heel 24.

' Strap 98 may be secured rigidly in position with relation to sole 76and the shoe, by a rivet or similar securing means 102. Holes 104, 106and 108 are provided, respectively, in, insole 12, portion 14 and sole76. Through these holes which are alined, rivet 102 is extendedpositively to anchor strap 98 with relation to the several parts of theshoe. For this purpose, hole 104 in insole 12 may be countersunk at 110so that head 112 of rivet 102 will'be flush with'face 82 of the insole.Lining 84, when .,.5 ,placed in-theshoe, then' will cover over beam-112posi tioned in countersunk portion 110. p f

Lacings 34 and 52, provided, respectively, for straps .20 and flaps 42(Fig. 12) function separately. Actual engagement of the foot is effectedby straps 20. Flaps .42 will function as a cover to conceal thefunctioning parts of bracing means 16. V

Now when a patientputs shoe on his-foot, lacings '52 and 34 are loosenedat flaps 42 and straps 20. The practitioner opens up straps 20, afterreleasing buckle 96 from strap 94, and sights through counter 60. Now hemay tighten lacing 3,4 to cause straps to engage against the foot whichusually will be standing upon the insole at location 114 on its toes.The heel of the foot, in the usual fashion, usually is, free of heel end116 of insole l2 and. the lining thereover. Tightening upon lacing 52 atflaps 42 is not suflicient to force the foot downward. Any manipulationsby the practitioner of the foot also will not cause the footsufficiently to approach or come into contact or retain its positionwith relation to heel end 116 of the insole. The foot, because of thenature of the paralysis, tends to resist movement -of its heel downagainstthe heel of the shoe,

The practitioner, looking through the window provided by counter 60,tightens lacing 34 at straps20. These :straps are diagonally disposed,as shown. The force ap- ,.plied to the foot causes it tobend about thetoes as a fulcrum, and to compel the heel portion of the foot to movedown against heel end-116. The doctor, watching as he applies.additional stress" to lacing 34 and as the :7 .heel of the foot isforced closer and closer to heel end 116, can govern this application offorce by visualizing the results of this manipulation through the windowprovided by the counter. i

The doctor may determine that, in a progressive man- .-ner, he does notdesire to apply all of this force .at one Thus, his inspection permitshim to determine stage. the extent of the adjustment he desires, as heapplies the necessary stress to lacing-34, and as heel of foot and heelof shoe approach each other.

After the adjustment desired by. the practitioner has been attainedfhethen may tie lacing 34, close up the shoe by tying lacing 52, and closethe window at counter .fl r e n 9t a asi ebn k1e 6w th straps" in theproper manner. Where a brace is used, the brace may have been assembledwith strap 98 either before or after such adjustment.

struction, and in specific .details thereof, hereinbefore set forth,without substantially departing from the inara e wholly inside the upperand'having extending ends extending diagonally upwardly and forwardly tobe lapped over the instep of the wearer, said extending ends carryingmeans for tightening the anchored means progressively for drawingthe'foot heel rearwardly towardand downwardly against the shoe heelwhile the degree of movement of the foot heel is being observed throughthe open portion and the counter, the forward extensions when closed bythe closing means providing means for covering the extending ends andthe tightening means.

2. In a shoe structure for use to facilitate orthopedic adjustments, thestructure comprising a sole, a heel, an insole, and an upper secured tothe sole, heel and insole,'the upper having an open portion at its rearportion associated with the heel, a counter associated with the insole,the heel and the upper at said open portion, the counter beingtranslucent at said open portion and with the open portion providing awindow for observing the position of the heel of the foot of the wearerwith relation to the heel of the shoe, the upper having for- Wardextensions away from its rear portion, said forward extensions carryingmeans for closing the upper around the foot of the wearer, bracingmembers having an end of each member superposed on and secured to a faceof the insole at a position approximately at the boundary between theheel'and sole of the shoe, the bracing members being wholly inside theupper and extending diagonally upwardly and forwardly from a positionsubstantiallylimmediately at said boundary and providing free ends to belapped over the instep of the wearer, said free ends carrying means forprogressively tightening the bracing members to apply a downward andrearward force against the foot of the wearer for drawing the foot heelrearwardly toward and downwardly against the shoe heel while the degreeof movement of the foot heel is being observed through the open portionand the connvention intended to bedefined herein, the specific de- 7scription being merely of embodiments capable of illustrating certainprinciples of the invention. What is claimed as new and useful is:

1. In a shoe structure for use to facilitate orthopedic adjustments, thestructure comprising a sole, a heel, and an upper havingthe sole andheel secured together therewith, the upper having an open portion at itsrear portion associated with the heel, a counter associated with theheel and the upper at said open portion, the counter being translucentat'said open portion and with the open portion providing a window forobserving the position of the heel of the foot of the wearer withrelation to the heel of the shoe, the upper having forward extensionsaway from its rear portion, said forward extensions carrying means forclosing. the upper around the foot of the wearer, and means anchored tothe shoe structure at a position approximately at the boundary betweenthe ter, the forward extensions when closed by the closing rneans'providing means for covering the extending ends and the tighteningmeans,-and means carried by the upper at the open portion for releasablycovering the counter. 3.- In a shoestructure for use to facilitateorthopedic adjustments, the structure comprising a sole, aheel, aninsoleextending over the sole and the heel, and an upper secured to thesole, heel and insole, the upper having an open portion at its rearportion associated with the heel, a counter associated with the insole,the heel and the upper at said open portion, the counter being formedwith a flange at its lower end and being translucent at said openportion, the counter with the open portion providing a window forobserving the position of the heel of the foot of the wearer withrelation to the heel of the shoe, the counter being mounted on the heelwith the heel end of the insole extending within the counter and restingupon the flange, the upper being turned upon and being secured insuperimposed relation to the-outer face of said flange and the bottomface of the insole, the upper having'forward extensions away from itsrear portion, said forward extensions carrying means for closing theupper around the foot of the wearer, bracing members having an end ofeach member superposed on and secured to a face of the insole at aposition approximately at the boundary between the heel and sole of theshoe, the bracing members being wholly inside the upper and extendingdiagonally upwardly and forwardly from a position substantiallyimmediately at said boundary and providing free ends to be lapped overthe instep of the wearer, said free ends carrying means forprogressively tightening the bracing members to apply a downward andrearward force against the foot of the wearer for drawing the foot heelrearwardly toward and downwardly against the shoe heel while the degreeof movement of the foot heel is being observed through the open portionand the counter, the forward extensions when closed by the closing meansproviding means for covering the extending ends and the tighteningmeans, and means carried by the upper at the open portion for releasablycovering the counter. a

4. In a shoe structure for use to facilitate orthopedic adjustments, thestructure comprising a sole, a heel, an

insole extending over the sole and the heel, and an upper secured to thesole, heel and insole, the upper having an open portion at its rearportion associated with the heel, a counter associated with the insole,the heel and the upper at said open portion, the counter being formedwith a flange at its lower end and being translucent at said openportion, the counter with the open portion providing a window forobserving the position of the heel of the foot of the wearer withrelation to the heel of the shoe, the counter being mounted on the heelwith the heel end of the insole extending within the counter and restingupon the flange, the upper being turned upon and being secured insuperimposed relation to the outer face of said flange and the bottomface of the insole, the upper having forward extensions away from itsrear portion, said forward extensions carrying means for closing theupper around the foot of the wearer, bracing means having an end of eachmember superposed on and secured to a face of the insole at a positionapproximately at the boundary between the heel and sole of the shoe, thebracing members being wholly inside the upper and extending diagonallyupwardly and forwardly from a position substantially immediately at saidboundary and providing free ends to be lapped over the instep of thewearer, said free ends carrying means for progressively tightening thebracing members to apply a downward and rearward force against the footof the wearer for drawing the foot heel rearwardly toward and downwardlyagainst the shoe heel while the degree of movement of the foot heel isbeing observed through the open portion and the counter, the forwardextensions when closed by the closing means providing means for coveringthe extending ends and the tightening means, flaps formed by the upperat the open portion, and means carried by the flaps for drawing theflaps releasably closed for covering the counter.

5. In a shoe structure for use to facilitate orthopedic adjustments, thestructure comprising a sole, a heel, a primary insole extending over thesole and the heel, and an upper secured to the sole, heel and primaryinsole,

' games the upper having an open portion at its rear portion associatedwith the heel, a secondary insole associated with and disposed upon theprimary insole at the heel and shank end of the primary insole, acounter associated with the insoles, the heel and the upper at said openportion, the counter being formed with a flange at its lower end andbeing translucent at said open portion, the counter with the openportion providing a window for observing the position of the heel of thefoot of the wearer with relation to the heel of the shoe, the counterbeing mounted on the heel with the heel ends of the insoles extendingwithin the counter and resting upon the flange, the upper being turnedupon and being secured in superimposed relation to the outer face ofsaid flange and the bottom faces of the insoles, the upper havingforward extensions away from its rear portion, said forward extensionscarrying means for closing the upper around the foot of the wearer,bracing members having an end of each member superposed on and securedto a face of the secondary insole at a position approximately at theboundary between the heel and sole of the shoe, the bracing membersbeing wholly inside the upper and extending diagonally upwardly andforwardly from a position substantially immediately at said boundary andproviding free ends to be lapped over the instep of the wearer, saidfree ends carrying means for progressively tightening the bracingmembers to apply a downward and rearward force against the foot of thewearer for drawing the foot heel rearwardly toward and downwardlyagainst the shoe heel while the degree of movement of tht foot heel isbeing observed through the open portion and the counter, the forwardextensions when closed by the closing means providing means for coveringthe extending ends and the tightening means, flaps formed by the upperat the open portion, and means carried by the flaps for drawing theflaps releasably closed for covering the counter.

References Cited in the file of this patent UNITED STATES PATENTS1,726,057 Cardamone Aug. 27, 1929 FOREIGN PATENTS 674,588 Great BritainJune 25, 1952

